Extended Infusion of Beta-Lactams Is Associated With Improved Outcomes in Pediatric Patients

Abstract

OBJECTIVE The pharmacokinetics of beta-lactam antibiotics favor administration via an extended infusion. Although literature supporting extended infusion beta-lactams exists in adults, few data are available to guide the practice in pediatrics. The purpose of this study was to compare clinical outcomes between extended and standard infusions in children. METHODS This retrospective chart analysis included hospitalized patients 0 to 18 years old who received at least 72 hours of cefepime, piperacillin-tazobactam, or meropenem between October 1, 2017, and March 31, 2019. Clinical outcomes of care included hospital length of stay, readmission within 30 days, and all-cause mortality. RESULTS A total of 551 patients (258 extended infusion, 293 standard infusion) met criteria for evaluation. Clinical outcomes among the entire population were similar. A subanalysis of select populations demonstrated decreased mortality in critical care patients (2.1% vs 19.6%, p = 0.006) and decreased 30-day readmission rates in bone marrow transplant patients (0% vs 50%, p = 0.012) who received the extended infusion compared with a standard infusion. CONCLUSIONS Outcomes were similar between extended and standard infusions in children. Subgroup analyses suggest a possible mortality benefit in the critically ill and decreased readmission rate in bone marrow transplant patients.

Prolonged Infusion of β-Lactams Decreases Mortality in Patients with Septic Shock: A Retrospective before-and-after Study

“…PI of β-lactams evolved as a reaction to a better understanding of the PK/PD index of this group of antibiotics whereby prolongation of the fT >MIC/ECOFF subsequently leads to a better antimicrobial exposure of the causative pathogens [33]. Previous investigations already suggested lower mortality rates and better clinical outcome using extended infusions in adults [23][24][25][34][35][36] and pediatric patients [37]. These effects are attributed to improved PK target attainment during extended infusions [36,[38][39][40].…”

Prolonged Infusion of ß-lactams Decreases Mortality in Patients with Septic Shock: A Retrospective Before-and-after Study

“…PI of -lactams evolved as a reaction to a better understanding of the PK/PD index of this group of antibiotics whereby prolongation of the fT>MIC/ECOFF subsequently leads to a better antimicrobial exposure of the causative pathogens [33]. Previous investigations already suggested lower mortality rates and better clinical outcome using extended infusions in adults [23][24][25][34][35][36] and pediatric patients [37]. These effects are attributed to improved PK target attainment during extended infusions [36,[38][39][40].…”

Advancing pediatric antimicrobial stewardship: Has pharmacodynamic dosing for gram-negative infections taken effect?

“…[4][5][6][7] Although these methods have shown enhanced clinical response rates and improvement in surrogate markers of outcomes in adults, only a small amount of published information has shown similar outcomes in pediatric patients. [8][9][10]22,23,[26][27][28][29][30][31][32][33][34] Unfortunately, because pediatric patients have different pharmacokinetic parameters than adults, the specifics of dosing optimization cannot be simply extrapolated from adult models. Monte Carlo simulations have been recommended as one method to help optimize pediatric antibiotic dosing.…”